Manila News November 20, 2022

Stages of Alzheimer’s  – Manila News

Alzheimer’s in the Philippines…

Stages of Alzheimer’s

When Alzheimer’s is diagnosed, few people know what to expect. Many people have heard that it is all about forgetting, that you can forget your own children or where you live. But most people believe that you can never truly forget your children—not me, not us, not mine. It’s difficult to believe that someone can forget how to chew, put on a jacket, or open a window, but it happens.

Stages of Alzheimer’s 

Experts have created stages of symptoms in order to help people understand what to expect. These stages are not compartmentalized; they frequently overlap and some events never occur. However, they provide a useful framework for families and doctors. Some people stay in certain stages for a longer or shorter period of time, and they can progress slowly or quickly; there are no set timetables. The total duration of these stages can easily range from three to twenty years.

The Seven Stages of Alzheimer’s Disease were developed by Barry Reisberg, M.D. and are based, in general, on the pattern of progression that corresponds to brain cell degeneration, which typically begins with damage to cells involved in learning and memory, gradually spreading to all aspects of thinking, judgment, and behavior, and eventually to the cells that control and coordinate all unconscious movement such as breathing, heart beat, digestion, blinking, swallowing saliva, and so on.

Stage 1: There is no impairment.

Stage 2: Mild cognitive decline that is easily confused with aging. Family, friends, and even doctors may not notice any problems, but patients may experience memory lapses and forget familiar words and locations of everyday items.

Coworkers, friends, and family notice mild cognitive decline at this stage. Patients experience difficulty remembering the names of newly introduced people, misplacement of valuable objects, and a decline in their ability to plan and organize.

Moderate cognitive decline is characterized by the inability to recall recent events; the inability to perform simple arithmetic such as counting backwards from 100 by 7’s; the inability to plan meals, pay bills, make change, or market; and the loss of memory of personal history. During social gatherings or mentally challenging situations, they may appear subdued and apart from others.

Stage 5: Moderately severe cognitive decline will result in significant memory gaps and cognitive function deficits. Patients are unable to recall important personal details such as phone numbers and addresses, but they will remember some information about themselves as well as the names of their spouse and children. They will be confused about the day, date, or season, and will require assistance with clothing selection and other day-to-day activities. They can still eat and use the restroom on their own.

Stage 6: Severe cognitive decline is characterized by significant personality changes and increased memory difficulties. Individuals require extensive assistance with everyday activities. They lose awareness of recent events; do not remember personal history correctly, forget name of spouse—but usually remember their own name; can generally distinguish between familiar and unfamiliar faces; without supervision will put clothes on incorrectly and backwards, shoes on wrong feet; sleep patterns become disrupted; need help with all phases of toileting and increasing urinary and fecal incontinence; become suspicious, delusional, have hallucinations;

State 7: The final stage is very severe cognitive decline. Individuals lose their ability to speak, though words or phrases may be heard on occasion, require assistance with eating, are unable to walk without assistance, sit without support or hold their heads erect, are unable to smile, reflexes become abnormal, muscles become rigid, and chewing and swallowing are impaired.

Doctors may use the term “Three Stages,” but they all follow the same general progression of loss. In general, the Early Stage (1) affects job performance, makes poor decisions, and lacks initiative; the Middle Stage (2) causes refusal to bathe, repetitive statements, and reading difficulties; and the Late Stage (3) causes weight loss, inability to recognize oneself in the mirror, and inability to communicate verbally.

Remember that stages overlap, some things never happen, and not everyone does everything at the same time. Remember that all normal people have memory lapses and other such issues from time to time; don’t assume it’s always Alzheimer’s.

The Caregiver and the Stages

It can be difficult to determine which stage of Alzheimer’s disease someone is in because each patient is unique, symptoms frequently overlap, some behaviors never occur, and duration times vary. There is some wiggle room and different designations, but the widely accepted Seven Stages of Alzheimer’s are depicted here, not only in terms of how they affect the patient, but also in terms of how they affect the caregiver. Comments for caregivers are available in (italics).

1. No impairment – Although the patient may have difficulty remembering names and finding the right words, he or she continues to function normally. Memory lapses are frequently attributed to aging, stress, and depression—and this may be the case. It is too early to tell whether or not the situation will progress to Alzheimer’s disease; it could be something else. Even doctors believe the patient is normal. (It is critical to consult a doctor as soon as even minor cognitive changes are noticed. Discover what it is. The sooner it is discovered, the better off everyone will be. Most people wait far too long. Legal, financial, and medical planning must be completed as soon as possible before cognitive decline worsens.)

2. Mild cognitive decline characterized by short-term memory loss, inability to learn and retain new information, depression, apathy, and refusal to seek treatment. Mood swings occur, anger emerges—sharp and sudden—and conflicts arise. Frustration will rise, and emotions will become more intense. Colleagues frequently notice changes first, but chalk them up to personal issues. The patient appears to be stubborn and self-centered. (When family and others do not believe the caregiver, he or she will become defensive, lash out and argue, accuse the loved one of being deliberately difficult, doing and saying hurtful things on purpose. Because these changes are not consistent and there will be many perfectly normal times, the caregiver believes it is all under control, but it is not. The caregiver realizes that the traditional approach will not work and seeks help from support groups and Web sites.)

3. Mild cognitive decline – Patients struggle to pay bills and manage their finances. They are unable to make change, calculate a tip, or decide what to purchase. They have difficulty accessing familiar websites and comprehending written material. They are victims of TV, phone, mail order, and internet scams. They struggle to take phone messages and are unable to use familiar tools. Guns become a hazard. They become reckless drivers. (It is the wise caregiver who acts quickly to prevent the loved one from accessing any significant amount of money. There are no exceptions: all firearms must be removed from the home. The main challenge now is to get them to stop driving. It can result in horrific scenes, but it must be done. Blame the doctor, who, hopefully, will cooperate and notify the authorities.)

4. Moderate cognitive decline – Patients obsess over the timing of events. They lose their reading comprehension and their ability to use a phone. They don’t notice things becoming dirty, the bathroom becoming soiled, and clutter accumulating. Cooking abilities have deteriorated. Making a sandwich is too complicated. Weight loss is possible. The stove and running water are left on, and the doors are not shut. The house is either too hot or too cold, and a loved one may be wearing a winter coat on a hot day. They withdraw from social activities, lose their sense of danger, become irritable, frustrated, self-absorbed, and incapable of planning ahead. They may deny having any memory issues and argue about it. They are upset about lost activities, particularly driving, and may lose their sense of humor. They will not recognize their own home and will long to return ‘home.’ (The caregiver is becoming increasingly irritable and frustrated, wondering, ‘What about ME and MY life?’ Caregivers learn not to tell loved ones anything ahead of time. They begin to lie to loved ones in order to avoid arguments and conflicts that cannot be resolved. It becomes more important to maintain calm than to win a pointless argument. The house and everything in it become a potential danger, the caregiver must be constantly vigilant and begins to lock up dangerous items, and social life is lost. Caregiver ignores his or her own well-being, misses medical appointments, is afraid to leave loved one alone, and feels trapped.)

5. Moderately severe cognitive decline – Loss of self-care. There is a refusal to bathe, a fear of water, a desire to wear the same clothes, getting angry about changing or laundering clothes, or they may change clothes frequently, selecting unusual combinations, and requiring assistance getting dressed. They occasionally forget about family and friends. They have difficulty understanding TV, mirrors, and innate objects, as well as excessive noise and stimulation. They repeat and repeat and repeat until they lose language ability, become increasingly self-centered, and are unable to reason or make decisions. clings to the caregiver Pacing, wandering, insomnia, late-day confusion, and’seeing’ others in the house all begin. (The caregiver considers quitting her job and hiring home care. TV must be watched. Caregiver cannot get a single minute alone, not even for a bathroom break, makes decisions without consulting loved one, and suffers from severe sleep deprivation. It’s difficult to bear constant repetition. When a loved one does not recognize family members, it breaks our hearts.)

6. Severe cognitive decline resulting in total loss of bladder and bowel control Shuffling, difficulty sitting or standing up, feet appear nailed to the floor, falls occur, head hangs forward, there is severe leaning, doesn’t know family at all, accuses them of stealing, impersonation, liars, and may become aggressive. Must be coaxed to eat, refuses food with clenched teeth or must be spoon-fed, may put non-food items in mouth, and picks up fictitious mites. There isn’t much language left. (The caregiver is physically, mentally, and emotionally exhausted. Health is suffering, and relief is often difficult to obtain. When faced with the decision to place a loved one in a care facility, guilt can be overwhelming and lead to inaction.)

7. Severe cognitive and physical decline – wanders aimlessly, relies on others for everything, forgets to chew and swallow, may choke on thin liquids, aspiration pneumonia is a possibility, severe weight loss Sleeps most of the time, has frequent urinary tract infections, lies motionless in bed, or assumes the fetal position. (It is a rare caregiver who can continue to do it on their own.) To save the caregiver, hospice or placement are required. Decisions about end-of-life care must be made if they have not already been made. Is that a feeding tube? Admission to a hospital? What should you do when your time as a caregiver is up? How to re-enter the labor force, make new friends, and build a life without a loved one?)

Patients may improve, have brief periods of lucidity, or deteriorate. Medications, other medical conditions, fatigue, excessive change or activity are all factors. (The best that the caregiver can do is the best that the caregiver can do—and the best that the caregiver can do is sufficient.)

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